How to Stop Hormone Replacement Therapy (HRT)

Co-authored by David Nazarian, MD

Last Updated: September 14, 2024 References

Hormone replacement therapy (HRT) is lifeline for many people, whether they are going through menopause or transitioning gender. However, you may decide to stop HRT for various reasons. If you’re ready to stop HRT, talk to your doctor to determine the best method for you. In most cases, the doctor will gradually reduce your dose over 4-6 months. This is because stopping HRT immediately may lead to overnight menopause or worsening menopause symptoms. ^{[1]
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Research source} That is why, when possible, your body should get time to adjust to its new hormone levels. Keep in mind that there may be some side effects. You may handle these symptoms using other treatments and lifestyle changes.

Part 1

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Visiting Your Doctor

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Talk to your doctor about why you want to stop HRT. Whether you are concerned about side effects or simply believe that you no longer need hormones, tell your doctor before you stop. Do not stop taking your medication without your doctor’s permission.
- How long you need to stay on HRT may depend on your condition and your doctor. While you can technically use hormones indefinitely, many doctors will stop treatment after 2-5 years.
- While each case can vary, it is generally recommended that transgender individuals remain on HRT until they are 50 to reduce the risk of osteoporosis. ^{[2]
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Ask your doctor what the risks of stopping HRT may be. Based on your age and medical history, you may be at higher risk of certain side effects. Make sure you are aware of these risks before stopping HRT. ^{[3]
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National Health Service (UK)
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- If you used HRT to ease menopause, symptoms may return, including hot flashes, vaginal dryness, anxiety, mood swings, muscle aches, or a reduced sex drive.
- If you had a history of vasomotor issues (such as hot flashes or heart palpitations) before taking HRT, ask your doctor how you can manage your symptoms once you have stopped taking hormones.
- While HRT can prevent osteoporosis from developing, your risk may return if you stop taking HRT.
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Work together to determine the best way of stopping hormones. In most cases, the doctor will recommend gradually weaning you off of your hormones. That said, if you have very severe side effects, your doctor may decide to end your treatment immediately.
- Gradually stopping HRT may reduce the risk and severity of side effects.
EXPERT TIP

Inge Hansen, PsyD
Clinical Psychologist
Dr. Inge Hansen, PsyD, is the Director of Well-Being at Stanford University and the Weiland Health Initiative. Dr. Hansen has professional interests in social justice and gender and sexual diversity. She earned her PsyD from the California School of Professional Psychology with specialized training in the area of gender and sexual identity. She is the co-author of The Ethical Sellout: Maintaining Your Integrity in the Age of Compromise.

Inge Hansen, PsyD
Clinical Psychologist

Our Expert Agrees: If you're on hormone replacement therapy, you can stop it for any time, and for any reason. For instance, you may only desire a partial effect from your hormones, or you may need to pause them because you're hoping to bring back fertility or because they're having an unintended side affect. However, it's always a good idea to seek guidance from your doctor before you stop. Also, be aware that some effects of hormones will reverse or partially reverse if you stop taking them, while other effects are more permanent.

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Stopping Hormones

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In most cases, you will wean off the hormones over the course of 4-6 months. If you decide to quit cold turkey, however, stop using the hormones immediately. ^{[4]
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Research source}
Your doctor may prescribe a lower dosage of hormones. If you take pills, your doctor may recommend that you cut the pill in half before taking it. ^{[5]
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In some cases, especially if you are using a patch or gel, your doctor will recommend that you use the hormones less often. Follow your doctor’s instructions for taking a less frequent dose. ^{[6]
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Because HRT can affect hormone levels, you may be at higher risk of some diseases, like osteoporosis, if you stop it. Continue to see your doctor regularly both during and after you stop using HRT. ^{[7]
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Dealing with Side Effects

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Exercise regularly. Exercise can help improve sleep and give you more energy. Do moderate to vigorous cardio 2-3 times a week. You can also do weight lifting and other strength training once or twice a week to protect your bones. ^{[8]
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National Health Service (UK)
Public healthcare system of the UK
Go to source}
- If you are going through menopause, exercise can reduce hot flashes.
- If you have recently stopped taking testosterone or estrogen, you may be at increased risk of weight gain. You can use exercise to maintain or lose weight. ^{[9]
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Undergo a bone mineral density screening. While HRT can prevent osteoporosis in menopausal women and transgender men, transgender women may be at higher risk of bone loss while on it. ^{[10]
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Trustworthy Source
PubMed Central
Journal archive from the U.S. National Institutes of Health
Go to source} Furthermore, once you are off HRT, your risk of osteoporosis may return. Once or twice a year, visit your doctor for a screening to make sure that your bones are healthy.
- In most cases, your doctor will scan your bones using a DEXA machine to determine your risk of getting a bone fracture.
- Staying active and taking supplements with calcium and vitamin D may be able to help protect your bones. ^{[11]
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  Public healthcare system of the UK
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Stress can worsen or trigger symptoms. Reducing stress and practicing relaxation techniques can help alleviate symptoms. You can try yoga, meditation, mindfulness, or deep breathing. ^{[12]
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HelpGuide
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Ask your doctor if non-hormonal medicines will help ease menopausal symptoms. Tibolone, clonidine, antidepressants, and gabapentin are sometimes prescribed to women instead of HRT to handle menopause symptoms. That said, these medications still carry some risk. Your doctor will let you know if these medications are right for you. ^{[13]
X
Trustworthy Source
National Health Service (UK)
Public healthcare system of the UK
Go to source}
- Tibolone can help ease hot flashes and improve your sex drive. It has similar side effects as HRT, including abdominal and pelvic pain, breast tenderness, and a higher risk of breast cancer.
- Clonidine has a milder effect on menopause symptoms, but it won’t affect your hormones. Side effects include dry mouth, drowsiness, depression, and constipation. ^{[14]
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  MedlinePlus
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- Antidepressants may help with hot flashes, ^{[15]
  X
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  BreastCancer.org
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  Go to source} but they have side effects such as dizziness, anxiety, agitation, and a reduced sex drive.
- Gabapentin can help treat hot flashes and insomnia during menopause. Side effects include headaches, dizziness, and sleepiness. ^{[16]
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  Research source}
If your symptoms persist for longer than 6 months or if they are interfering with your quality of life, consider restarting HRT. Talk to your doctor to learn what your options are. ^{[17]
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National Health Service (UK)
Public healthcare system of the UK
Go to source}

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Am I able to stop gender-affirming hormone therapy once I've started?

Inge Hansen, PsyD
Clinical Psychologist
Dr. Inge Hansen, PsyD, is the Director of Well-Being at Stanford University and the Weiland Health Initiative. Dr. Hansen has professional interests in social justice and gender and sexual diversity. She earned her PsyD from the California School of Professional Psychology with specialized training in the area of gender and sexual identity. She is the co-author of The Ethical Sellout: Maintaining Your Integrity in the Age of Compromise.

Inge Hansen, PsyD

Clinical Psychologist

Expert Answer

You can stop hormone replacement therapy at any time. However, some of the effects may reverse while others will be more permanent. Talk to your doctor first before you stop taking hormones.

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How to Stop Hormone Replacement Therapy (HRT)

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Visiting Your Doctor

Stopping Hormones

Dealing with Side Effects

Expert Q&A

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